Abstract
OBJECTIVES: This study aimed to investigate the effects of long-term and habitual physical activity on mortality and long-term care insurance (LTCI) certification among cancer survivors using a population database. DESIGN: 5-year retrospective study. SETTING: 13 Japanese municipalities participated in the Longevity Improvement & Fair Evidence study. PARTICIPANTS: Among 471 511 participants who underwent health check-ups, 39 435 met the following eligible criteria: documented in the cancer claims database without a suspected diagnosis and participated in a health check-up at least once in a 12-month period, had no missing exercise data and had already been certified for LTCI. MAIN OUTCOME MEASURES: Outcomes were new LTCI certification and all-cause mortality. LTCI certification was assigned by a trained local government official through a systematic process (involving various items-physical function, daily activity function, cognitive function, behavioural disorders, adjustment to social life and daily use of medical services-as well as overall consideration of computer-based and specialist team assessments), and the LTCI severity level correlates with the Barthel index. LTCI certification reflects some impairment in activities of daily living. All-cause mortality was defined based on claims data. RESULTS: Three physical activity categories, 'exercise and walking', 'exercise or walking' and 'no physical activity', were used. Among survivors aged 65-74 years, the 'no physical activity' group had a higher risk of mortality and LTCI certification than the 'exercise and walking' group (adjusted model HR: 1.72, 95% CI 1.52 to 1.94). Among survivors aged ≥75 years, the low physical activity groups had a higher risk of mortality and LTCI certification than the 'exercise and walking' group (adjusted model: 'exercise or walking', HR: 1.51, 95% CI 1.29 to 1.85; 'no physical activity', HR: 1.66, 95% CI 1.43 to 1.92). The effects of physical activity differed according to cancer type. CONCLUSIONS: Habitual physical activity had positive effects on cancer survivors. These effects differed according to age and cancer type.